CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 685 321.250000 11950.5000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 5 2.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1776 5845.500000 217480.5000 37.2048
Subtotal (Total Children Is Unduplicated) 1789 6168.750000 229431.0000 37.1925
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Screening, Eval, and Assessment,Class #02
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 24.2800 24.2800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.9200 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 31.8100 31.8100
EXIT-EXIT-COS Exit 64 64.000000 3200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.500000 283.4300 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 2.500000 202.4500 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 3.500000 283.4300 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 4.000000 323.9200 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.500000 283.4300 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 4.500000 269.6400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 6.500000 389.4800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 116 137.500000 11113.6900 80.8268
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 111 135.500000 10972.7900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 99 117.500000 9515.1500 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 103 134.500000 10891.8100 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 48 57.500000 4656.3500 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 45 57.000000 4584.2700 80.4258
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 129 157.500000 9470.6200 60.1309
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 117 153.500000 9197.7200 59.9200
Subtotal (Total Children Is Unduplicated) 466 1047.500000 75864.1500 72.4240
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 65 64.000000 3189.5000 49.8359
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 315 275.250000 13725.0000 49.8638
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 36 37.500000 900.0000 24.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 5 4.000000 200.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 5 5.000000 250.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 2.750000 87.5000 31.8182
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 809 5388.750000 295111.5000 54.7644
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 178 835.250000 44995.5000 53.8707
EPIC-99601-Early Steps Professional Development Fee 465 3126.000000 46557.0000 14.8935
INTR-T1013-INTERPRETER 45 302.000000 20880.0000 69.1391
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 408 2607.000000 31047.0000 11.9091
OCCT-97530-OT SESSION BY LICENSED OT 9 36.000000 2602.2400 72.2844
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 6 23.500000 1858.0800 79.0672
OCCT-97530HM-OT SESSION BY OT ASST 2 6.500000 423.2800 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.500000 97.6800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 18 123.750000 10023.3500 80.9968
PHY-97110GT-PT SESSION BY LICENSED PT 5 12.000000 970.0600 80.8383
PHY-97110HM-PT SESSION BY PT ASST 8 48.000000 2944.3600 61.3408
PHY-97110HMGT-PT SESSION BY PT ASST 4 16.000000 976.8000 61.0500
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 31 164.250000 13356.8100 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 20 77.750000 6322.6300 81.3200
Subtotal (Total Children Is Unduplicated) 1136 13164.25000 496848.3700 37.7422
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Total 20380.500000 802143.5200 39.3584
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Number of Children (Unduplicated) With at Least One Service 1872
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Center 06
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 4063 4147.000000 122001.4700 122001.4700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
19460 16177.500000 677265.8300 0.0000
Other 80 56.000000 2876.2200 0.0000
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Total 23603 20380.500000 802143.5200 122001.4700